Long-Term Care Survey Alert

Revisions are effective Oct. 1, 2016.

Delirium and cognition loss are among the Care Area Trigger (CAT) specifications that the Centers for Medicare & Medicaid Services (CMS) recently revised. CMS also added a sub-item to record an acute onset of change in mental status. Read on to learn which draft MDS 3.0 Item Set version will get overhauled.

Take Note: New Item C1310

In the new draft MDS 3.0 Item Set version 1.14.0, set to be effective for October 2016, CMS removed Item C1300 and essentially replaced it with the new Item C1310 — Signs and Symptoms of Delirium (from CAM^©). Because of this major item revision, CMS also revised the CATs (1) Delirium and (2) Cognitive Loss/Dementia.

The new CAT specs v1.02.0 is for OBRA comprehensive assessments with an assessment reference date (ARD) on or after Oct. 1, 2016.

In the new Item C1310, CMS removed the sub-item for psychomotor retardation and added a sub-item to record an acute onset of change in mental status. Just like for the old Item C1300, you must complete the Brief Interview for Mental Status (BIMS) or Staff Assessment and review the medical record before coding Item C1310.

In the new sub-item C1310A — Acute Onset Mental Status Change, you must code either 0 — No or 1 — Yes for “Is there evidence of an acute change in mental status from the resident’s baseline?” The rest of the sub-items for C1310 are:

• C1310B — Inattention – Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said?
• C1310C — Disorganized thinking – Was the resident’s thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
• C1310D — Altered level of consciousness – Did the resident have altered level of consciousness as indicated by any of the following criteria?

vigilant – startled easily to any sound or touch
lethargic – repeatedly dozed off when being asked questions, but responded to voice or touch
stuporous – very difficult to arouse and keep aroused for the interview
comatose – could not be aroused

Coding for sub-items B through D require that you code one of the following responses:

0 — Behavior not present;
1 — Behavior continuously present, does not fluctuate; OR
2 — Behavior present, fluctuates (comes and goes, changes in severity).

CMS Throws Out Old Delirium CAT

On Dec. 21, 2015 CMS released the revised CAT Specifications Version 1.02.0 that will revise CATs (1) Delirium and (2) Cognitive Loss/Dementia. The CAT specs changes directly address the replacement of Item C1300 with C1310.

Old way: The previous triggering conditions for (1) Delirium were:

1. Worsening mental status is indicated by the BIMS summary score having a non-missing value of 00 to 15 on both the current non-admission comprehensive assessment (A0310A = 03, 04 or 05) and the prior assessment, and the summary score on the current non-admission assessment being less than the prior assessment as indicated by:

(A0310A = 03, 04, OR 05) AND

((C0500 >= 0) AND (C0500 <= 15)) AND
((V0100D >= 0) AND (V0100D <= 15)) AND
(C0500 < V0100D)

2. Acute mental status change is indicated on the current comprehensive assessment as follows:

C1600 = 1

What the New Delirium Triggering Conditions Look Like

 

New way: The new triggering conditions for (1) Delirium are as follows:

1. Symptoms of delirium are indicated by the presence of an acute mental status change and/or the presence of inattention, disorganized thinking or altered mental status as indicated by either of the two sets of logic:

a)         C1310A = 1

AND

C1310B = 1 or 2

AND EITHER

C1310C = 1 or 2 OR C1310D = 1 or 2

b)         C1310B, C1310C, or C1310D = 2

AND

C1310B = 1 or 2

AND EITHER

C1310C = 1 or 2 OR C1310D = 1 or 2

Understand Changes to Cognitive Loss/Dementia CAT

The CAT specifications for (2) Cognitive Loss/Dementia have also changed due to the new Item C1310.

Old way: The previous triggering conditions for (2) Cognitive Loss/Dementia impacted by the C1300 item deletion are:

5. BIMS, staff assessment or clinical record suggests presence of inattention, disorganized thinking, and altered level of consciousness or psychomotor retardation as indicated by:
(C1300A = 1 OR C1300A = 2) OR
(C1300B = 1 OR C1300B = 2) OR
(C1300C = 1 OR C1300C = 2) OR
(C1300D = 1 OR C1300D = 2)

And the old relevant part of the pseudocode is:

*Trigger on Condition 5;

IF ((C1300A = ‘1’) OR (C1300A = ‘2’)) OR

((C1300B = ‘1’) OR (C1300B = ‘2’)) OR
((C1300C = ‘1’) OR (C1300C = ‘2’)) OR
((C1300D = ‘1’) OR (C1300D = ‘2’)) THEN V0200A02A = ‘1’; 

New way: The new triggering conditions for (2) Cognitive Loss/Dementia are largely the same, except for Number 5 below:

1. BIMS summary score is less than 13 as indicated by:

C0500 >= 00 AND C0500 < 13

2. BIMS summary score has a missing value and there is a problem with short-term memory as indicated by:

(C0500 = 99, -, OR ^) AND
(C0700 = 1)

3. BIMS summary score has a missing value and there is a problem with long-term memory as indicated by:

(C0500 = 00, -, OR ^) AND
(C0800 =1)

4. BIMS summary score has missing value of 99 or – and at least some difficulty making decisions regarding tasks of daily life as indicated by:

(C0500 = 99, -, OR ^) AND
(C1000 >= 1 AND C1000 <=3)

5. BIMS, staff assessment, or clinical record suggests presence of inattention, disorganized thinking, or altered level of consciousness, as indicated by:

(C1310B = 1 OR C1310B = 2) OR
(C1310C = 1 OR C1310C =2) OR
(C1310D = 1 OR C1310D = 2)

6. Presence of any behavioral symptom (verbal, physical, or other) as indicated by:
(E0200A >= 1 AND E0200A <=3) OR
(E0200B >= 1 AND E0200B <= 3) OR
(E0200C >= 1 AND E0200C <= 3)

7. Rejection of care occurred at least 1 day in the past 7 days as indicated by:

E0800 >= 1 AND E0800 <= 3

8. Wandering occurred at least one day in the past seven days as indicated by:

E0900 >= 1 AND E0900 <= 3

And the new part of the pseudocode is as follows:

*Trigger on Condition 5;

IF ((C1310B = ‘1’) OR (C1310B = ‘2’)) OR

((C1310C = ‘1’) OR (C1310C = ‘2’)) OR                   

((C1310D = ‘1’) OR (C1310D = ‘2’)) THEN V0200A02A = ‘1’;

Resources: You can find the new v1.02.0 of the CAT specifications and the associated documents at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-CAT-Specification.zip. Or, go to www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html, and then scroll to the Downloads section at the bottom of the page and look for the Zip file.